 It's my pleasure to introduce our final speaker in our Gender Equity and Ethics series. I want to first welcome the speakers that are the attendance virtually as well as the audience here in P117. It is my distinct pleasure to welcome Dr. Julie Euler as our speaker today. Also want to acknowledge that she has been the force behind the Gender Equity and Ethics series that we have had. So Dr. Euler is a professor and associate program director for the University of Chicago Internal Medicine Residency Program. She completed her undergraduate education at Stanford University and then came to University of Chicago for her medical degree, her internal medicine residency, followed by her chief residency. She developed University of Chicago Medicine's quality improvement curriculum, which is a two year curriculum that's been used to teach over 500 internal medicine residents, some of whom are in the audience, practice based learning and improvement as well as systems based practice. It's also been used as the basis of curricula for all over the country in internal medicine residency program training. She currently is the co-director for the healthcare delivery improvement science track at University of Chicago Pritzker School of Medicine, which was developed to train medical student leaders in quality improvement and patient safety and can claim graduates who are currently chief quality and safety officers at other fine institutions. Dr. Euler teaches quality improvement and patient safety for the Association of American Medical Colleges Teach for Quality program, the Society of Hospital Medicines Quality and Safety Educator Academy and the American College of Physicians Advanced Quality Improvement Program. She's on the committee to revise the AMC Quality Improvement patient safety competencies as well as provides QI coaching for individuals and practices through ACP Advanced. She currently practices as a primary care provider here on the south side of Chicago. She has been chair of the University of Chicago Department of Medicine Women's Committee since 2017 and has led very important initiatives such as presence of women on the walls initiative in the Department of Medicine, as well as increasing awards given to female faculty and academics, which was a very powerful initiative that has led to increase a third for our internal faculty awardees. So without further ado, I do want to acknowledge and please join me in a warm welcome to Dr. Euler and thanking her for all of her contributions to gender equity and ethics. Thank you. Thank you, Vinnie. And to the audience, I really appreciated learning with all of you this year. Can everybody hear me okay? So here's the CME code and I'm excited to get us started about where do we go from here? Improving gender equity is an ethical imperative. So here are learning objectives. We're going to describe current gender equity successes at the University of Chicago, summarize the 28 gender equity talks that we had this year in the McLean lecture series and discuss future goals for gender equity here. So I get some funding from the ACP, but really my most relevant experience for this talk is being the daughter of a very strong mother who had five different careers over my lifetime as a social worker, a florist, a teacher and finished her career as a clinical psychologist at the end after I was already a physician, went back for training, but really a female mentor in my life that inspired me. And I am also the daughter of a very strong male ally, my father, and he was the original, you know, what's your plan? What are you going to do? How are you going to move up? Not knowing anything about medicine, but just really the confidant of asking me questions. And also a very strong female sister who is an associate medical dean at the University of Alabama. And so we, this has been part of my life for a long time. And when I came to the University of Chicago in 1997 for medical school, my class was 50% female. And this was one of the draws that there were so many female leaders. Normal Wagner was the dean at the time, you know, followed by Dr. Humphrey and now Dr. Aurora. And I just saw the University of Chicago as a place where females could be leaders. We had multiple strong physician leaders throughout, starting with, you know, Dr. Rowley in oncology, Dr. Cougar Ross in psychiatry, and so many others. You know, if we look at currently our, our gender equity statistics in the Department of Medicine, we have about 325 faculty of which 43% are female. And it's very similar in the biological sciences division. There are about 1000 faculty and this has actually increased from 40 to 43% over the last four or five years. So we have made some strides. There really has not been a unifying rallying for us for gender equity within our physician scientists. And I would argue that we still have work to do in this area. So as I walk throughout my career, I had so many strong female mentors, which I'll thank at the end. But one of them, many of them were in this Department of Medicine, Women's Committee. It was formed in 1999, really to address gender specific issues in the Department of Medicine, and to enhance the academic environment for women and, and trainees through networking, mentorship to professional development and advocacy. And so we have a very strong structure where we have subcommittees. Dr. Volerman leads our leads our advocacy subcommittee. Dr. Ruiz and dermatology just took over our professional development committee. Dr. Hoisin sheets took over for Dr. Press in a newly formed committee that we started when I became the chair to really nominate women for every award in the institution. And then Adriana Olson in emergency medicine is in charge of our newsletter, which we send out and I'll tell you more details about. So a really strong commitment within the Department of Medicine, we have 25 faculty members on the committee, one from every section, we spend five year terms and we also have training representation. And it was really within that committee that I worked with Dr. Aurora and others and my sub and my subcommittee leads, I'm mentored by Dr. Burnett to really use these three hours to elevate gender equity. And so I'm going to use these three hours as a framework throughout our talk today. And that is recognition, representation and resources. But as I took on senior roles, what I noticed is more and more board meetings and things that I was sitting in were primarily men. And so we're used, tried to use these three hours to make some changes. And so the first question we ask is how is gender equity recognized at your hospital and institution? This is the awards work that Dr. Aurora mentioned that we published on simply by nominating women for each internal award. We had increased the awards from 36 to 59 percent. And we are now like stretching out to look at national and regional awards. So sometimes it's just a matter of nominating is how you can get women nominate to get the awards that lead to promotions and things. We also really highlight accomplishments and speaking opportunities. And I'll show you that data here. So our whole committee pitched in to really evaluate the number of speakers at ground rounds and how gender equity was represented. So you can see here from 2004 to 2020, we separated out into internal speakers in the blue and external speakers in the red. So there is variability from year to year, but you can see both are increasing. However, the internal speakers got to a rat at the end of 2020, which is when we stopped counting right before the pandemic, the internal speakers really got to the 43 percent, which is our representation of female faculty within the department. Our external speakers was still lower. You can see like around 33 percent. I presented this back to the section chiefs and anecdotally, we've seen an increase in female speakers in our grand rounds, and we are planning to go back and evaluate this data. But just by talking about it and showing the data is really how you bring awareness to this. We also do recognition through newsletter and our website. So in 2012, the Women's Committee launched the first newsletter just to really highlight the accomplishments of women, faculty, and trainees, disseminate information relevant to women physician scientists. We send it out twice a year, so hopefully all of you in the audience get it. And if you want to see them, they're all located on our website, which I noted below. We also provide a peek into the work balance, the work-life balance of women faculty, so people can see all the things that women faculty are juggling. And we also take a look at all the grass roots level, things that the medical students and our trainees are doing to support themselves and others. So the next question is representation. How is gender equity represented at your hospital and institution? And the first thing I'll focus on is structural changes, and then I'll show you a few sides about leadership changes. So when I first started as the chair of the Department of Medicine Women's Committee, we had a hallway in the Department of Medicine that looked like this picture on the left, which is like all of the chairman of the Department of Medicine over the years, which were all white men. And when you walked into the if you walked into meet with the chairman, that was what you would see. And so we advocated and our chairman, Dr. Vokes, was especially supportive in and giving some money to put some more women on the walls, including this prominent women section that balances out. We also put the chief residents up there and and you'll see we also have this executive committee and our section chief counsel. So now if you walk into our department, the women on the wall, there are more women on the walls, there's more diversity on the walls and it if you're a trainee or a student, it feel or even a young faculty, it's a place that you could see yourself maturing and becoming, you know, one of the senior faculty. And we also started tracking the leadership opportunities in our section. So this one is it goes from right to left. So right is 2016 and we have had some significant some increases in our female section chiefs in red. That's just under 40% right now. We are female faculty has pretty much been stable at 43% over that time that we've been tracking. And our executive committee, you can see Dr. Vokes really grew the committee and increased representation for females between 2016 and 17. And then it's been steady around 50% since that time. So just by looking at the data acknowledging I think that's one of the things that I've seen that that really affects and brings to light how we can evaluate representation and gender equity. We also took a look at resources. I would not take credit for this myself. We but we did have a salary equity study that was not widely published I think because of some the controversy around it but we were shown it and I will talk about salary equity evaluation at the end. Also the the Department of Medicine Women's Committee really started with like childcare resources and lactation resources and that has become pretty standard I'd say for those of you new to the institution having bright horizons was part of that early advocacy and some of the lactation resources we have. And then Anna Volerman has compelled elder care resources we've done infertility counseling and Dr. Volerman and Dr. Aurora and Dr. Olapati applied for this NIH grant. Oh, we got the NIH prize for enhancing faculty gender diversity and I'll talk about that grant in just a second. We've also advocated for parental leave. Dr. Ortiz Worthington is here in the in the audience worked with Dr. Volerman and one of our former trainees Dr. Feld to really just write these perspective pieces on supporting trainees in their parental leave and also breastfeeding. And so advocating for those things at the institution and nationally has really been a part of the work of the Women's Committee. And that led me to work with Dr. Seigler and then Dr. Angelo's to start this gender equity series. And I'm really excited about the 28 speakers that we've invited over the last over the last year. I'm going to take a one minute per per for those of you who are not able to be there. I tried to pick out some of the main highlights. So for the next 25 minutes or so, I'm going to just summarize for you what we learned over the course of this gender equity lecture series. So Dr. Aurora started she really did a tour to force overview of gender equity. And one of the new things that I learned from her was this term gender justice. And you can see that gender justice is not just women's rights. It really centers on gender based discrimination and to work towards a world that affirms the lives of all people, racial justice, trans and queer rights, women's rights, immigrants rights, just education justice, reproductive justice, anti violence. So it's just it's bigger than just, you know, a women's committee. It's it's a whole and I think we tried to put speakers together that kind of represented gender justice. That was followed by Dr. Gottlieb. She came from the University of Massachusetts and she with Dr. Jags, he had published some significant work on closing the gender pay gap in medicine. And the real takeaway that I got from her talk was start somewhere, do something. Don't let it paralyze you. You know, she recommended conducting regular salary audits to determine these salary inequities, identifying where the gender pay gap is most concerning. Sometimes that's with incoming salaries. Sometimes that's the promotion when people don't get promoted, they stay at the same salary. And she talked about this framework of this compensation methodology that are that that includes the drivers of disparities, including, you know, differences in based salaries, difference in productivity bonuses and how part-time work and domestic duties and women spending more time with patients might affect that productivity. And in addition to the leaves we've talked about. And then she also talked about the leadership premiums and women not getting leadership and how that sometimes affects salary equity in addition to rank and seniority. And so really started us off with this like push towards closing the gender pay gap. Then we had Dr. Rajma Jagsi. She was at Michigan. She's now at Emory and radiation oncology. And this graph on the left really highlights the the department, the increase in department chairs and the deans. And you can see there has been improvement from the 1980s till now. But it really if you look towards gender parity at 50 percent, we don't really reach that till 2070. So you can see lots of room to grow to go. And she really talked about not fixing the women but fixing the systems. And she focused on mentorship and sponsorship and kind of summarized many of the things that she's done research with on and a lot of the data that she's found in her work. That was followed by Dr. Jesse Gold, who is a psychiatrist at Washington University. Dr. Gold kind of slowed us down a little bit and talked about women in medicine are burned out. Now what do we do? And how can we address burnout? And the first thing she talked about is just policy level things that affect burnout and the vulnerability of sharing mental health issues. This this graph on the left is a map of the United States and it looks at the state board application rules with recommendations on physician wellness and burnout. So a state that meets all four would be a state that you're able to acknowledge your mental health that you don't feel like you when you reapply for your license that you don't have to hide anything. And so a state that has four would be the best kind of states. A state that has zero would be states where people feel uncomfortable acknowledging burnout and mental health. And so you can see Illinois as a two. So some room to grow to to grow in Illinois. And then she slowed us down even more and asked us to like start with self check ins check in on others. Acknowledging vulnerability as a strength that mental health is not you know, a downfall, but it's something that makes us better clinicians and how we can become more vulnerable. And then she talked about five tips for individual coping with the kind of psychiatrist view of allowing space for feelings, practice self compassion. And really that leaders need help to that leaders don't have to be perfect. And I think that is a good acknowledgement for all of us. So Dr. Gold was followed by Dr. Moyer. Dr. Moyer is one of the CEO of the American College of Physicians. And she her title was and then there was four and I was like what is that title mean? And I'll tell you at the end. So she talked about gender equity and national leadership and really focusing on her work with the ACP. She showed us this picture of 1982 ACP governor's meeting, which there were very few women in that meeting. And she said since that time, ACP has been very involved with policy and advocacy about gender equity, forging collaborations, which we'll talk about in the second affinity groups within the ACP state organizations. And then they really revised their national award and master'ship descriptions to be more inclusive. And they also started tracking and reviewing data and publications. So in 1987, only 1% of the ACP board of governors were female. And that increased to 23% in 2007. And she was just in the midst of getting more updated data. They also look at their they award masters of ACP and in 2007, only 9% were women were masters, which improved to 32% in 2021, but some room to go in that area also. And then in 2021, they looked at their awards that they gave at their national conference, and they only had 22% of the national ACP awards were given to women. So just starting to acknowledge that there was some room for growth. They joined this Council for Medical Specialty societies. There are 48 societies that are part of those. Many of our societies are part of this Council for Medical Specialties. And then there were four meant that there were four women CEOs of these of these national societies in ACOG, ACS, ACP and CMS. So still some room to grow. And I think she was acknowledging that and her role in that. We were then I'm joined by argobon sales, who's from Stanford. And Dr. Sales was very vulnerable about us experiencing sexual harassment and kind of naming this pyramid for sexual harassment that starts really at the bottom with a power differential that many people feel in medicine and then progresses on to harassment because of gender, sexual attention and coercion. And she went through kind of a survivor's timeline from when the harassment started here to confusion about what to do with it to mental emotional distress to when it was reported and then kind of the like, you know, not a clean line, but kind of the mishmash of things that happened, including legal fees and career loss and changes therapy, relationship strain and then a settlement, and then still not knowing where to go from there. So I think it was a kind of vulnerable and honest discussion about sexual harassment in the medical setting and what happens when the loss that happens when it happens in medicine. That was followed by Dr. Marshall from University of Pennsylvania who talked about motherhood and medicine and, you know, many of us have seen this graph with on the right, which talks about the fertility rate which is higher in young women 20 in their 20s and decreases significantly to women in their 40s. And then also the increase of spontaneous abortions or miscarriages. And that is overlapped with basically the exact time for medical training and expected early career productivity. So she proposed this just the fact solution, which includes flexibility for for young mother's autonomy to be in charge of the schedule, having childcare options, allowing for time off and then also sponsorship and mentorship. And one of the other things that I love, which is not fit in to this facts is that she really, I think she built this schedule for all the things that a parent responsible for children does at work, including the expected pre-work and post-work meetings plus notes. And then the same kind of life schedule that's happening at the same time, just acknowledging kind of the burden that not just mothers but parents carry who are physicians and working. That was followed by Dr. Cortina, who's at University of Michigan. And she really was part of this consensus report that was done by the National Academy of Science, Engineering and Medicine on the Sexual Harassment of Women. And they she focused on this iceberg model, which we saw many times during the course of the lecture series that really very few of these come ons happen. And that's, but that is where most of the policies and procedures are oriented. And many more of the things that actually happen in medicine are these put downs, including derisive remarks or gendered contempt. And the question was, what are we really doing at the bottom of the iceberg? She also talked about how common it was. And I think I was shocked by the difference of medicine versus the other STEM sciences. So you can see in this large university system in the Southwest, this is the percentage that for instance, gender harassment happens. And in medicine, 45% compared to engineering and science or non stem. I think that was just shocking to me. I had not seen it presented that way. And and so you can see the other things about gender harassment, unwanted sexual attention, and sexual corrosion are a little bit more similar, but still higher in medicine. And I, I guess I didn't know that when I went into medicine and I didn't sense it until I saw that data. And then she summarized with how we can better prevent and respond to sexual harassment. And she really talked about this culture of respect. It's not, it's that we work at institutional level to develop this institution culture of respect within hiring, evaluation and promotion within our everyday practices and also within our built environment, which I will talk about later. That led us to Dr. Silver. Dr. Silver is a PM and our physician from Harvard. And Dr. Silver has published a number of papers that will recited multiple times over the course of the lecture series. What I was most interested in is how she got into the work. And what she did was she looked at Harvard's promotion criteria for professor to medicine. And then she did research on publication of senior authors in books and in papers. She published this and then she looked at authors of guidelines and how many times they were female. She looked at again at the senior author publications. She also looked at visiting professors, professorships and invitations to speak nationally. So this like who's speaking at the institutions and published on that she published on leadership roles started within her own PM and our institution and then published some of the national data. You know, she also talked about editors and journals and is published on multiple journals and what percent females are editors. And then really talked about peer reviewed funding and other national leadership missions. And then she summed up with this is that, you know, women institutions hire and make a huge financial commitment to to women physicians and then and then there's becomes this like the gender barriers that happen and some women leave academic medicine and those who say sometimes they move up more slowly and if if they if they move up at all. And so really inspired us to kind of look at our promotion guidelines and what are we doing to change those and think about those. Dr. Melissa Gilliam, who was a former OB Guine here as now the provost at the Ohio State University and she introduced the kind of concept of this academic ecosystem talking about her role at Ohio State and she as a dean, how she is a diversity champion, changing practices for hiring, looking at leadership, holding leaders accountable and yourself accountable, interrupting power structures and also brought up this concept of wellness. So there was a number of themes that were kind of continually repeated over the course of the of the lecture series. And then we had Dr. Conroy, who is the CEO and at Dartmouth Health, and she really talked about not only academic medicine, but also hospital based medicine and health care and in general as the CEO, she's in charge of everything. And she talked about this concept that women really make 80 percent of the decisions in health care. And this includes RMAs and our RNs. And so how involved women are in medicine. But then when you look at the Board of Governance, CEOs and CEOs of top hospitals, it really drops off significantly. And she talked about her role as a CEO at Dartmouth Health. And she, you know, gave us more data about the percentage of CEOs that are women in health care, the percentage of CMOs that are women, looking at deans in department chairs and division chiefs. I think for me is just an emphasis on we need to keep looking at our data, like what what's our data, our institution, what's our data nationally. And she reiterated some things about authorship that we had heard before. And then she kind of summarized with these tenants for gender equity, examining a recruitment process and the leadership team. Again, she brought up respect so that word of respect came up multiple times, creating visibility and recognition at a seat at the table. She talked about, you know, looking at the data and disaggregating the data and then also brought up this transparent approach to pay even if it's if it's uncomfortable to like show salaries, you still have to do it. And then talking about it's not just something that women do. And I think this happens at multiple levels, that it's everyone's job, not just women to talk about gender inequality. And then Dr. Peek really inspired us, as she always does, talking about the intersectionality of the systems of oppression. And I think for me, the eye opening thing was, I think I maybe perhaps the white man is sometimes, you know, criticized. But I what she showed is that also white women have a role in in that intersectionality of oppression. And she talked about Emmett Till and his accuser who recently passed away and how much power, you know, this white woman had over this African American young boy and how that might, you know, flow into our into the clinic where me as a white woman and my interactions with with, you know, black men. And I was really, I was really impacted by that and really changed my practice about not only white men, but also white women have have maybe abused power. She also talked about racism within anti sexism. So within the women's rights movements, sometimes there was groups of African American suffragettes that were not always recognized or included in the movement. She also talks about sexism within anti racism. So within the civil rights movement, there were some unheard black women that weren't acknowledged as part of the process. And then she ended with these invisible visits of black middle class women in the American healthcare system and really brought to light some of the times that middle class African American women have not been heard. And I think for me it was really impactful to kind of recognize all these intersectionalities and bring them into my clinical practice and think about how we're addressing these topics here. That was followed by a panel on allyship and gender equity. Dr. Shikha Jane at UIC and also the CEO of Women in Medicine Summit runs an inclusive leadership lab for men to participate in how to be better allies. And she brought two of her allies, Jeremy Yardley in Pediatrics and David Smith who's a PhD at Hopkins. And they really talked about developing allyship principles, showing persistent interpersonal support and genuine partnership for women, thoughtful and intentional development of trusted confidence as a man to ask how you are being seen and supporting and then counteracting challenges to perceiving and taking action against bias, bias harassing, sexist, sexist language and behavior and basically brought us to the consensus of wow, if you hear something like wow, can I just acknowledge what was said right there if I'm the attending physician in a clinical setting or hear something in the clinic, not just letting it pass but acknowledging it right there. And then talking about clarity and transparency and accountability in a gender inclusive workplace. And then that was followed by Dr. Stella Safo who's at Mount Sinai. Dr. Safo talked about navigating adversity and healthcare and was shared about experience of harassment at Mount Sinai. And she was very vulnerable talking about there was a group of people that were seen that felt that were harassed. And at first they weren't acknowledging what was happening. They trusted the institution would do something about a harasser was not they didn't document it in real time and they expected the institution would do the right thing and weren't they didn't plan ahead but they did band together. They created this justice now organization and they saw legal representation. They learned about their rights. They learned documentation made a little noise and created an advocacy platform. And so I think it was an eye opening lecture to hear about an experience of a significant harassment event and how to work at the institution where it was still happening. And so she recommended these tools to survive and thrive include including knowing your rights documenting HR is not your friend that maybe cringe a little bit. I just you know HR sometimes is your friend. But in that experience they did not feel like it at Mount Sinai. They learned various modalities for self protection and advocacy and be prepared for blowback and how to deal with that. So it was quite an eye opening talk and I it was just interesting to learn about how that might happen. Then Dr Humphrey who of course was our dean for medical education is now at the Macy Institute came and talked about gender equity in medical education. We convened a group of medical educators to listen to her in a small group of setting three four hand and Dr Humphrey talked about flourishing in medical education and really talked about these case studies in gender based medical student mistreatment gender bias and assessment and pregnancy maternity leave and I I showed I shared with you one of the examples here. Dr Humphrey showed this four by four table of support and how to support a trainee. This being low support and this being high support and and in a challenge as a leader low challenge versus high challenge and she recommended that we really push ourselves into this growth mindset here that if there was this case study of a young woman who experienced mistreatment on during a surge of rotation and she recommended this kind of response I will speak to the program doctor and to the attending your experience in the OR was unacceptable furthermore we will make sure that you have time in the sim lab to practice skills if you feel you need to more educational opportunities so really pushing ourselves not to retreat not to stasis not to just confirm like oh that's terrible but to this area of growth and so we really grew from Dr Humphrey's expertise in gender equity and medical education medical education. Then we had Dr Ross who of course was one of our ethics greats here at University of Chicago has recently moved for leadership position at Rochester and she came back to share with us publisher parish woman is authors and peer reviewers and pediatrics and so you can see she looked at many three different journals jama pediatrics pediatrics and journal pediatrics and then she summarized the work here these are first other publications which has been increasing up to 60% and then she looked at senior author which increased at a slightly slower rate and she looked at the editorial board and she gave us these three takeaways that female representation on editorial boards continues to parallel female representation of senior authors that the rise of women as first and last authors between 2016 to 2021 is the same and that women were historically under represented in pediatrics as first authors but have increased faster than their growth as junior female faculty a female junior faculty so she talked about pediatrics as an area where they're more than 70% of the pediatricians are females and they have like kind of grown more during than their than their growth in pediatrics. That was followed by a very own Dr. Paul who's in gastroenterology here who talked about overcoming the challenges mitigating disparities and lgbtq community. She gave us this amazing history of lgbtq health starting in 1952 and homosexuality was still labeled a mental disorder and then kind of ending in March of 2021 when our first transgender leader was named to the be the assistant health secretary and she kind of summarized in her talk steps for inclusive training programs including openly discussing inclusivity and recruiting diverse training groups support for identity based training at the GME level and having we I'll tell you a picture and a few slides about our outpatient group having mentoring and also research and education improving our lgbtq curriculum and education at all levels. And then putting pronouns on email zoom and social media having inclusive benefit packets which she acknowledged that University Chicago has has grown and has fairly good inclusive benefits packages now and then supporting out trainees and doing that consciously. That was followed by Dr. Yana Gallan who is across the street in public policy and she used these network and networking is did research in public policy and she took a hundred students and some of them were law some business, none medical and and 10,000 professionals and she used she said a networking platform which I asked her later was linked in and she had the students really modify their profile take personal stuff out of there just really their education. She had the students rank their professionals and select which professionals they wanted to email and then they each sent a hundred messages and and then over three weeks they just they saw how many responses they got back they rated the calculated response rates they looked at career attributes and they looked at the length and sediment and word usage of responses and then they also looked at career plans. So on the left here is what the students wanted to get from this experience you can see not too many differences. You know they wanted to hear about daily tests and the jobs, maybe a little bit more women wanted to hear about the career trajectory and growth similarities until we get to hear which which is interesting that women this 10 where I put the arrow is a work life balance. And you know men wanted to hear about work life balance even more than women and that is not what happened in their findings when the professionals responded to these students more of those professionals talked about work life balance in the response emails. They had two times more mentions of work life balance when they had the students sent a broad email question. They had a and then the students were also instructed to send a specific like what is the work life balance in your career. And those questions got 28% more responses than the other kind of broad and culture questions. They really got no gender differences in the workplace culture question no difference in responses. And they she kind of summarized that there was suggestive evidence of gender gaps in the information and that might lead to gender gaps in career decisions so really interesting kind of policy level research. That was followed by Dr. Volerman who gave us talk on gender equity and caregiving. And and in her final recommendation she talked about institutional level things that could be done including policy work and flexible start and end times and telehealth options adjusting calls and RV use for leave and lactation which I know our surgery colleagues are working on and the revisiting the traditional promotion and tenure timelines. As a community she talked about childcare and elder care and services. And then at a policy level talking about this paid parental leave and paid sick leave. And then finally she introduced the work that she Dr. Aurora and Dr. Olapati are doing as they were able to get a grant to fund COVID the COVID 19 fund to retain clinical scientists which are these 10 members here which they are funding out of the COVID pandemic trying to support those with young families and make sure that their research doesn't tailor off because of the stress that they had during the COVID pandemic. That was then followed by Dr. Carl Street who's a graduate of the University of Chicago and now in Boston and he talked about beyond binaries. He really emphasized understanding kind of the sexual orientation gender identity terminology. Making sure that physicians are aware and that we as educators and physicians are aware of those things. He also talked about kind of the generational changes that are happening and how we as faculty and trainees need to be aware of kind of the increase in the generation Z where it's the total LGBTQ plus community is definitely growing and health care needs to be prepared for that. He also met with our students and our residents in our outpatient groups and was able to support them and give them ideas for change. And his final recommendations were these ensuring collection of SOGI data in the electronic health record and incorporating LGBTQ content into our curricula and requiring CME even for more senior faculty for LGBTQ health. And he also focused on cardiovascular health disparities which is his specific area of interest. That was followed by Dr. Pringle Miller who has started this physician for just equity and organization. She's a graduate of the University of Chicago living in California but working at UIC and she really supports people who have gone through harassment or issues that have happened within their workplace and they this to distance for just equity those people would reach out. They assign them a navigator and they engage a team and they meet with the person who has experienced harassment and they really support them through the process because there really is no kind of external to your institution if something happens how do you how do you walk through that. So she talked about what physicians for just equity does how they do research and outreach and education was also really inspiring what she's done with her work. That was followed by a state of women in surgery a panel of our surgery colleagues who talked about microaggressions in surgery and I think I was interested here when they compared medical students, residents and attendings how high this attending for feeling like second class citizens was here and also just how high all of these were for environmental validations and assumption of traditional gender roles. So they presented interesting data that was surgery focused. They also talked about sources of discrimination is not always the same. So if you think about gender discrimination in surgery at least it came primarily from patients or nursing staff. In this in this study if you talk about verbal or emotional abuse that mostly came from attendings. When you talk about physical abuse lower numbers but also attending they talked about sexual harassment. It was a variety of patients and and and attendings but also men noted that they got sexual harassed sexual harassment from nurses and then in pregnancy or child care discrimination. Sometimes that added co-residents peers like you're putting a burden on me when you're taking time off. And so that was followed by our colleague Dr. Dr. Kor from OB who talked about gender equity and family planning and noted in how after and 1960s after contraception was introduced in the pregnancy rates declined in the 18 to 19 and 20 to 24 year olds and then Planned Parenthood and how that affected. She also talked about at that same time as contraception was in was coming on to play and rates of pregnancies were decreasing that you know there was increasing matriculants to medical school and applicants to medical school and talked about kind of where we have gone with medical school applications. And then she also talked about Roe versus Wade and how in our current society there is you know such varied access across the nation Illinois of course being in in teal the expanded access but surrounded by a number of states that have either hostile or not protected access and kind of summarize to summarize her work this access to contraception and abortion has contributed gender equity not all genders receive equitable family planning that the use of contraception of abortion is highly prevalent among US physicians and fosters gender equity and these threats that we're experiencing now to contraception and abortion are threats to bodily autonomy justice and undermining gender equity. So we have a couple more left this was the CEO of a Morehouse medicine who was able to meet with some of our underrepresented medicine residents and faculty and really talked about there's no health without wealth and so she talked about educational debt which you can see here is the highest for African-American women and then African-American men but also high in in other in other races and so she talked about longitudinal associations between wealth and health and wrecking the impact of this unrealized potential on gender inequality and then she talked about the role of education as the equalizer in achieving health equity and this is her kind of career trajectory that she showed she moved up in socioeconomic status from her time in rural Georgia to her time as president CEO and then she named all of the educational mentors and sponsors who really lifted her up in that time and so that was inspiring to me that was also followed by Paula Martin who is one of our colleagues across the in at the college talked about intervention ethics and trans youth she had gone to a clinic in California and observed over a hundred kind of discussions between a physician and transgender youth and their parents and she really kind of brought home the terminology and also the stories of these families the providers and the children about how to you know support gender diverse children and she talked about this this concept of persistence versus desistence also talked about possible timelines of intervention where families maybe start with social changes like changing hair and changing changing what you wear and then moving on to more medical and kind of decisions and so she summarized this that defy denying gender affirming care creates massive inequalities and healthcare for trans youth and at really challenged me actually are the expectations for trans youth matched by expectations for their cisgender counterparts so when questions were asked of her she said like would you ask that of a cis a cisgender young person and and oftentimes we kind of treat the questions differently and so that was summed up by last week we had Dr. Weiler here from Florida who talked use the double AMC data to look at gender disparities in rank and tenure at American medical centers and they compared they use double AMC data to look at the basic science kind of increase in promotions to assistant professor and the clinical science promotions to assistant professor you can see that the expectation is that right around now we are achieving gender parity in assistant professors there's a little bit of room to go in basic science assistant professors but when you as you walk through associate and fall and when she walked and when she talked about basic science full professors and clinical science full professors we have between 20 and 30 years to go before we reach gender parity she also talked about this academic medicine timeline and really went over 40 years and how the changes in medicine have affected kind of promotion so really inspired some changes here so I'm just going to use the last 15 minutes to to sum up what we can do at the University of Chicago and then I'd love to hear discussion and I'm going to focus back on this recognition representation and resources so in recognition I think we have not really looked at tracking BSD and departmental level of awards and we have not looked at all at tracking national and regional awards at least from our institution outwards so but love to see some tracking of awards more globally salary equity I know that the the fact is looking and talking with salary equity and making some proposals to the dean and and talking about how that could be more transparent and I think that is really important for those of us have been asking for that for many years promotion equity I think we might be a little bit more behind on but working with OAA to think about what at what rates are are people promoted and how much time are they spending in their rank and tracking that data I think what I've learned in my role is that data really speaks and so if we're able to look at that data and evaluate it that could lead to some growth for us at the university and also speaking opportunities thinking about you know we looked at department medicine grand rounds I'm not sure what happens in surgery grand rounds or site grand rounds what happens at the hospital level like who's speaking and who are people hearing speak and is it equal and equitable and are we measuring that I took a look at our hospital leadership yesterday and so it's at a BSD level it's broken down into basic science chairs which you can see is the highest at 30% female with three of the 10 basic science chairs being female and our clinical chairs two of 14 and that's new because of course Tessa Baloch was just named as the orthopedics chair but we typically I think this is what I've seen is that there's been a little bit slower uptake in leadership and we need to be at least looking and tracking that data there's also the academic deans of which three years of 17 are female and that's not even asking the question do we have you know what are of the we didn't even talk about racial diversity and other and other diversity within these people so I think looking at it evaluating ourselves and asking for asking for data is really important when we talk about structural changes we had there was some structural changes if you walk in the LS entrance there is now kind of some more representation on the walls that is diverse and and recognizes kind of like the work that many people do it within the biological sciences division we of course have always had our pictures of medical schools in the hallway so as you walk to P 117 you can see that and that brings some diversity but we of course are sitting in P 117 I don't know if any of you have had a chance to look at the walls Dr. Burnett and I have been evaluating these are four you know people historic figures at the University of Chicago who have had scientific expertise or clinical expertise and should be honored but I think we also think that there it should be a place that we sit for many many lectures and celebrations that should represent the people sitting in the room and so we we raised a little bit of money and put a proposal together to how we could change this and these were the people that we propose and this proposal has been sitting for a little bit with COVID but we hope to continue to advocate for funding and also just to acknowledge like these were significant historic figures at the University of Chicago and to acknowledge they're from all different departments they're from all different areas of research and just to see and there are also some some diversity to see people that you know that had amazing scientific discoveries but also is more reflective of who's sitting in the room so we I think for resources there has been some structure but not a lot of structure for gender equity at the University of Chicago surgery has a new women's committee for the last year they've had this led by Dr. Ferris pediatrics has had a women's committee that's had two or three different leaders currently led by Dr. Darlington and Dr. Williams but we've been proposing a gender equity committee that there will be would be a committee that would kind of bring these groups together not only medicine and surgery and pediatrics but also radiology has a diversity inclusion council and also representation from other specialties also including basic science and perhaps in later states the hospital and that this committee would really have 12 to 15 members they would have a professional development subcommittee and mostly as I've been talking data really speaks so having a data subcommittee so we do submit data to the W.A.M.C. on our hospital and we have access to the W.A.M.C. I think many of our speakers mentioned that so I have that data the Office of Faculty Affairs has that data but who is really looking at that data and asking how we can improve it what are we doing with the data I think we submit without without using it and so really tracking this what is the gender equity in the B.S.D. and are in each department at the leadership level what's our data for promotion and salary equity I think these are all areas where data really speaks and can push this effort forward and I think a committee could really like keep this focus and keep encouraging these moving these things forward so again a dashboard of data and then the Advocacy Subcommittee one of the things that I have learned is that it really is not just about parental leave for women and that as long as we equalize and men and women and anyone who takes one stake parental leave is able to take it then it becomes everyone's job to like balance a family and raise that family up and so the surgery department has really been focusing on scripts for staff what do you say when people leave when they're coming back who's going to cover do we have support for coverage and then we don't have lactation policies some there's individual like when you have clinic like how much time you can take off for lactation we don't have that for trainees at all and we don't have a universal policy so working on that and then also this ramp up and ramp down time I think surgeons specifically but for many of us work compression like you do the same amount of work in the nine months of the year that you would do in the three months in the 12 months of the year when you when you're on leave and like acknowledging and acknowledging that and having policies for that one of the things we also leave on the table is is national conferences I was lucky to be part to be nominated to go to this double AMC early career faculty development it really helps me to see what promotion was like at other places but I'm not sure that we're nominating someone on a regular basis and I think this committee would make sure that we are annually sending someone here there's also a mid career faculty development opportunity that we could take advantage of and then there is Elan the executive leadership in academic medicine Dr. Burnett took part of that and a few other faculty University Chicago but we have not on a regular basis sent a leader there to have extra training we have not nominated someone on a regular basis so having some kind of you know some kind of plan to how we would nominate support someone every year you have to you have to get awarded it so someone might not get awarded every year but at least we have a plan to do that on a regular basis this is also bring us alignment with our peer institutions there are deans for gender equity at many of our peer institutions other places like Colorado have gender equity task force so I think we need some kind of structure here at the University of Chicago to kind of coalesce these efforts together oh and I should have mentioned that this this women in medicine summit and there's a leadership accelerator that we could be sending people to one of our faculty Dr. Press has been part of that but we are just not taking advantage of things that are out there perhaps for financial but perhaps just because we don't have a structure to do it you know some of the areas we talked about like wellness we have had new new plan of course we have Dr. Bre Andrews our new chief wellness officer and I think there are plans around that to focus on that kind of slowing down that Dr. Gold brought us to sexual harassment I don't know maybe other people in the audience know but we at the university or the college is part of the National Academy's collaborative but we in the hospital and the BSD I'm not sure are accessing yet there's no kind of how do we you know talk about harassment do we have data about microaggressions how often it's happening how would we report it who would we report it to as the chair of the Women's Committee IOC people often come to me and you know and so there's all these questions about how bad is that to me to go to title nine and then you're often working with a leader who may or may not understand or support so I think we could have better kind of policies and reporting for sexual harassment for allyship I don't think we have any training now on allyship there is this inclusive leadership lab which recommendations we could be sending male allies there to really talk about this LGBTQ plus and transgender health we're having increasing education in a separate role I'm doing with some students I'm working on they are really engaging with our DE and I office about soji training and how this is going to roll out with like a required CME I think maybe later this summer for all faculty and also just making it more acceptable for our patients maybe you are familiar that our patients were asked to put their pronouns in and gender preferred gender into the my chart and we did get 32,000 responses but that's only one percent of our patient populations so we as an institution need to do better to make it an accept inclusive environment for our patients and our staff and trainees and then intersectionality I think you know I have been got the benefit of implicit bias training through some of the recruitment things that we've been doing but I don't know that we do that on a regular basis here and then increase support for DI and data tracking in that intersection intersectionality area so with that oh with one minute left I would just like to conclude that we have made great strides in gender equity over the last few decades but I think if we were going to focus on some increased areas for improvement we should really develop a centralized structure and support for gender equity like that BST gender equity committee that we should really work towards with back and the OAA transparent salary and promotion equity because I think I get asked about that a lot and finally I think there's some really tangible structural changes that we could make including this room to support gender equity so I just like to to summarize with thanks to this is the members of the Department of Medicine Women's Committee the staff Morgan Ealy and Nancy Zavalin and that Westerburg Dr. Rora had to run to her senior scientific but Dr. Rora and Dr. Vincy have been mentors to me personally and then finally some of our leaders Dr. Vokes and Dr. Anderson and I just like to end with a huge thanks to our ethics staff. I don't know if you know Bita Makarachi has been a new ethics staff and is you know having a hybrid lecture series has had not been without its flaws but has done a really great job of managing Zoom participants and putting these up on the McLean website and Dr. Angelo so of course for his new leadership and then the rest of the staff Renana I don't know if you know has been on Zoom in the background recording all these and so the ethics staff has really done a tremendous job in running this ethics lecture series and then finally to my family who you know as I have moved through the University of Chicago has been a tremendous support of source of strength for me so I will summarize there and we can take time for questions or thoughts or ideas about how you think we should move forward at the University of Chicago Bita Any thoughts or ideas? Yes Can you say that one more time? The gender parity you talk about gender Yeah, oh interesting so I know a little bit about this from you know being an internal medicine associate program director but I don't know about like every I don't know if I could speak to every program I know the medical school focuses on it and I wish Dr. Aurora would be here to talk about that but I know that for instance in internal medicine I'll use an example is that we had been at 50% and then 50% women and men in internal medicine residency and then we slipped to 6040 and we asked ourselves why like why was that happening and we really had to intentionally interview more women and rank more women on our internal medicine rank list I'm two of the leaders of the selection committee are sitting right here and they could give you the details we had to do that so that we would reach gender parity and so that's a local example I'm not sure if that's happening at a at a university example but I think that we do need to be aware of it and I think my interactions with the surgical my surgical colleagues is that they also have to be very aware of it but I think it's a great thing is like are we tracking it are we watching it do we have to be very intentional earlier on as your point right yeah thank you for that anything else great well thank you for participating in the lecture series the ethics fellows if you want to come down and just say one last you know discussion I'd love to chat with you one more time but thank you again and it was great to this is the concludes the ethics lecture series so thanks